Facility Evaluation Report

Licensing Program Analyst (LPA) Lopez conducted an unannounced case management inspection and met with Administrator, Paulina Lopez and House Manager, Viridiana Agapoff . The purpose of this case management inspection was to obtain additional information regarding a self reported incident submitted to Community Care Licensing (CCL) on 10/13/21, 12/12/21 and 12/22/21.

On 10/20/21 CCL received an incident report reporting an unwitnessed fall. Administrator stated that they believe that Staff #1 (S1) was sleeping on shift. S1 is no longer working with facility according to Administrator. Facility had staff training regarding unwitnessed falls. LPA was given a copy of proof of all staff training and additional documentation.

On 12/12/21 and 12/22/21, Resident #1 (R1) was having behavioral issues. Facility contacted physician multiple times for guidance. According to Administrator, R1 is now doing better. LPA requested documentation and conducted interviews. Facility will request a new physician report from physician.

Exit interview conducted with Administrator, Paulina Lopez. Report given.